Nursing homes are responsible for not only the quality of the medical and physical care of residents, but also for quality of life that residents are able to achieve. Residents, their families, regulators and providers are all vitally concerned that facilities provide environments that afford each resident the best opportunity for privacy, dignity, autonomy, social interaction and other aspects of a high quality of life. It is widely recognized, however, that the quality of life of nursing home residents often falls short of ideal. The physical environment is a major factor in the lives of nursing home residents. Despite the importance the environment in shaping the everyday lives of nursing home residents its effect on quality of life has not been studied systematically controlling for relevant variables such as resident case mix, staffing levels, and administrative policies that also influence quality of life. The proposed career development award will involve training activities designed to give the candidate a strong understanding of the clinical aspects of caring for nursing home residents, a deep understanding of the way physical environments are designed and used, and knowledge and skills for measuring costs associated with residential care for the elderly. The proposed research project will accomplish the following specific aims: 1. Determine the relationship between features of the nursing home environment and quality of life for different subgroups of residents. 2. Estimate the potential improvement in quality of life from modifying the environment. 3. Estimate the cost associated with environmental modifications. The proposed study will provide data on the impact on resident quality of life of the nursing home environment at the room, unit and facility level. By focusing on how different features of the physical environment promote or inhibit high quality of life for subgroups of residents, it will be possible to make concrete recommendations that can be used to guide quality improvement efforts.